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SHOULDER Solutions by Tornier
A EQUAL IS™ RE V ERSED FR AC T U RE S U R G I C A L T E C H N I Q U E
Aequalis™ Reversed Fracture
surgical technique
AEQUALIS™ REVERSED FRACTURE SURGICAL TECHNIQUE
SHOULDER
PROTHESIS
Aequalis™ Reversed Fracture
table of contents
NICE LOOP DESCRIPTION P. 4
1. PRODUCT DESCRIPTION
2. THE DOUBLED SUTURE NICE KNOT TECHNIQUE
IMPLANT P. 6
1. INDICATIONS
2. CONTRE-INDICATIONS
SURGICAL TECHNIQUE P. 7
1. PREOPERATIVE PLANNING
2. PATIENT POSITIONING
3. SURGICAL APPROACH
4. FRACTURE EXPOSURE
5. GLENOID EXPOSURE AND PREPARATION
6. PREPARATION OF THE HUMERUS
6.1 Humeral Reaming
6.2 Drilling of diaphyseal Sutures Holes
6.3 Positioning of the Trial Stem
6.4 Placing the Bone Graft
6.5 Cementing the Implant
6.6 Placement of Final Humeral Implant
6.7 Impaction of Humeral Insert
6.8 Reduction
6.9 Tuberosities fixation
6.10 Trial and Closure
7. REHABILITATION
8. COMPLICATIONS
9. AEQUALIS™-REVERSED NON REVERSED HEMI-PROSTHESIS ADAPTOR TECHNIQUE
9.1 Preparation of Metaphyseal Implant
9.2 Affixing Union Screw
9.3 Implantation of Adaptor
9.4 Impaction of Humeral Head
10. ASSEMBLY OF PROSTHESIS HOLDER
10.1 Prosthesis Holder Components
10.2 Assembly of Height Gauge
10.3 Assembly of Prosthesis Holder
10.4 Assembly of Retroversion Rod
COLOR CODING
P. 24
INSTRUMENTATION
P. 26
IMPLANTS
P. 28
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nice loop description
1.
DESCRIPTION
The Tornier NiceLoop™ is the dedicated solution to perform the NiceKnot, a sliding and self stabilizing knot, invented by
Pascal Boileau M.D, PhD, in Nice (France).
For more information about the NiceKnot, Please refer to the WhitePaper “The Doubled Suture NiceKnot” (ref. UKNA121)
NiceLoop™ Properties:
• The NiceLoop™ is tied as a doubled-over suture.
• The tightening process of the NiceKnot can be stopped and resumed
at any stage, as the knot is self stabilized (preventing from slippage).
• The NiceLoop™ can be used in a variety situations:
-Tuberosities Fixation during Hemi or reversed arthroplasty for fracture
- Cerclage for Humerotomy or Femorotomy
- Fixation of Bone Fragments (i.e Butterfly).
• By combining a simple initial knot with 3 half hitches, the NiceKnot provides
knot security without an excessive amount of complexity and bulkiness.
NiceLoop™ Specifications:
• Available in 3 colors: Solid White, Solid Green, White/Green
• 60cm (24 inches) long loop (doubled-over)
• Braided PTFE Impregnated Polyester Fiber Nonabsorbable Surgical Suture
• Needle: KAC-25, 1/2 Circle, K-Point (49mm).
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2. THE DOUBLED SUTURE NICE KNOT
TECHNIQUE
Fig. 1a
• The following is a step-by-step description of how this
knot is made:
• Use a Nice loop
• Pass the suture around the tissues to be fixed (Fig. 1a)
• Use a square knot using the loop on one hand and the
needled limb on the other (Fig. 1b)
• Cut the needled limb (Fig. 1c)
• Open the loop and pass both free limbs through it (Fig. c),
then dress the knot by making the loop smaller (Fig. 1d).
• When ready to secure the involved tissues, tighten down
the sliding knot either by pulling the two free limbs apart
(Fig. 1e) – as done during open surgery – or by pulling the
free limbs (acting as the post) back towards you – which is
most useful during arthroscopic surgery.
NOTE :
As with other sliding knots, while the post is being pulled
back, the knot can be helped down manually to reduce the
traction forces seen by the tissues around which the sutures
are sliding. Another way to reduce such traction forces is
pulling the post’s two free limbs separately in alternation
(but still in the same axis). - Finally, perform three
alternating half-hitches or surgeon’s knots using the two
separated free limbs (Fig. 1e). This precludes the possibility
that the free limbs slide back out of the loop, thus securing
the knot definitively.
* Secure the Knot definitively with the three alternating
half-hitches.
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Fig. 1b
Fig. 1c
Fig. 1d
Fig. 1e
implant
1. INDICATIONS AND CONTRAINDICATIONS
The Aequalis™ Reversed Fracture Shoulder Prosthesis is indicated for patients with a functional deltoid muscle
as a total shoulder replacement for the relief of pain or significant disability following arthropathy associated to a
grossly deficient rotator cuff joint:
• In case of traumatic or pathologic conditions of the shoulder resulting in fracture of the glenohumeral joint,
including humeral head fracture and displaced 3-or 4-part proximal humeral fractures, or
• In case of bone defect in the proximal humerus.
The Aequalis™ Reversed Fracture Shoulder Prosthesis is also indicated for prosthetic revisions with a grossly
deficient rotator cuff joint when other treatments or devices have failed.
The Aequalis™ Reversed Fracture Shoulder humeral stem is used in association with the glenoid components of
the Aequalis™ Reversed Shoulder Prosthesis.
The Aequalis™ Reversed Fracture Shoulder humeral stem is for cemented use only.
A complete list of contraindications can be found in the “Instructions For Use“ packaged with the implants.
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surgical technique
1. PREOPERATIVE PLANNING
Thorough patient evaluation with history and physical examination is advised.
Evaluation of the contralateral shoulder should be done since there can be limited range of rotation with a
reversed prosthesis. The deltoid muscle must be evaluated by clinical examination. Weakness of the deltoid does
not constitute a strict contraindication to a reversed fracture prosthesis.
The preoperative studies should include computed tomographic (CT) scan to classify the fracture, determine the
displacement and status of the tuberosities, evaluate indirectly the status of the rotator cuff by analysis of fatty
infiltration of the muscles and assess the glenoid bone stock.
Bilateral X-rays of the whole humerus allow evaluation of bone loss in comminuted fractures and help the
surgeon estimate the approximate stem height of the prosthesis by comparing measurements of the contralateral
side of the humerus with measurements of the fractured side.
2. PATIENT POSITIONING
Patient is placed in a beach chair position with the shoulder off the table.
The patient is vertically inclined to the angle determined according to the surgical approach selected.
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surgical technique
3. SURGICAL APPROACH
The superolateral approach is usually recommended for
these cases.
Patient is placed in a beach chair position.
A longitudinal incision is made, starting from the
acromioclavicular ligament and running distally for 4 cm
following the anterior edge of the acromion.
The anterior and middle deltoid muscles are separated with
respect to the lateral edge of the acromion.
It is important to be careful with the dissection to avoid an
axillary nerve injury since this nerve is found about 4 cm
away on the lateral side of the acromion. (Fig. 2)
Fig. 2
The deltopectoral approach can also be used.
4. FRACTURE EXPOSURE
The first step is to identify the fracture fragments. (Fig. 3a-b)
Once the fragments have been identified, the supraspinatus
tendon is resected to the glenoid rim.
The humeral head fragment is removed and a tenotomy of the
long head of the biceps is done. The intra-articular portion is
then resected. The ligament will be tenodesed with suture to the
transverse ligament before closing.
Fig. 3a
The greater tuberosties is mobilized posteriorly and 2 green
Nice Loop sutures are placed in Infraspinatus and 2 white Nice
loop sutures are placed in Teres Minor. For each tendon, enter
the first one from inside to outside and cut the needle of the
suture. Enter the second suture from outside to inside leaving
the needle in place in order to fix the LT afterwards.
NOTE :
For each tendon, the sutures are clipped with a Kelly clamp in
order to ease their identification and manipulation.
Fig. 3b
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surgical technique
5. GLENOID EXPOSURE AND PREPARATION
The characteristics of the fracture usually allow easy exposure of the glenoid. (Fig. 4)
The various surgical steps for exposure and implantation of the baseplate and glenoid sphere are described in the
Surgical Technique of Aequalis™ Reversed (UDXT151 et UDXT145):
Fig. 4
NOTE :
•Instability is a considerable risk when a reversed prosthesis is used for fracture as a result of:
- Lack of reliable anatomic landmarks
• To avoid instability:
- Inferiorly position the base plate.
- Position the humeral implant to the correct height using the greater tuberosity as a landmark.
The prosthesis should not be implanted lower than the superior edge of the greater tuberosity.
- The greater tuberosity must be reduced with the arm in neutral position.
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surgical technique
6. PREPARATION OF THE HUMERUS
6.1 Humeral Reaming
The medullary canal of the humeral shaft is progressively
reamed with reamers of increasing diameter (7, 9, 11, 13,
15 mm) until the reamer contacts the cortical bone. (Fig. 5)
Fig. 5
The last reamer used determines the size of the humeral
stem.
Each diameter corresponds to a color code that easily
identifies which instrument to use. (Fig. 6)
The reamers are marked at depths that correspond to the
necessary reaming length according to the chosen stem.
NOTE :
In case of revision, it is important to remove as much
cement residue as possible to not interfere with tuberosity
consolidation.
6.2 Drilling of diaphyseal Sutures Holes
Fig. 6
Two holes are drilled laterally in the bicipital groove 2 cm
under the fracture site using a regular 2.7 mm drill bit (not
included in instrumentation).
The first Nice loop suture is placed from outside to inside on
the anterior hole, this suture is then placed from inside to
outside in the posterior hole. This suture will be used to fix the
infraspinatus.
The second Nice loop is placed in the posterior hole from
outside to inside and from inside to outside into the anterior
hole. This suture will be used to fix the subscapularis.
They will be used as a shroud to secure the fixation of the
tuberosities at the end of the procedure. (Fig. 7)
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Fig. 7
surgical technique
6.3 Positioning the Trial Stem
6.3.1 Retroversion
The trial stem is introduced in the medullary canal.
Adjust the retroversion with the retroversion rod. It has to be parallel to the patient’s forearm. The guide
retroversion is adjusted to 20° relative to epicondyles (25° in relation to the forearm).
The second retroversion rod can be used as an orthogonal landmark by placing it on the wrist.
A mark is made with electrocautery at the lateral fin of the stem and will be used as a landmark to position the
definitive implant (Fig. 8 - zoom 1)
zoom 1
zoom 2
Fig. 8
NOTE :
The assembly of the guide is detailed pages 24-25.
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surgical technique
6.3.2 Selecting the Height
To select the proper height, place the superior aspect of the
trial implant to the superior edge of the reduced greater
tuberosity. (Fig. 9)
Inspect the reduction of the greater tuberosity for
confirmation of proper positioning of the stem.
The reduction with trial implant can be done once the
prosthesis holder is removed.
The prosthesis must be stable upon insertion and before the
tuberosities can be reduced.
If the stem sits too low, insert the next larger trial stem.
Fig. 9
Once the appropriate height has been achieved, position the
height gauge on an anatomic landmark. The height is then
read on the ruler ( (Fig. 8 - zoom 2)
This reference will be used again when the final implant is
put into place.
6.4 Placing the Bone Graft
Bone grafting is recommended to enhance consolidation of
the tuberosities.
Two bone grafts are harvested from the humeral head in the
bone graft cutter. In case of revision, or if the bone quality
of the humeral head is not sufficient, autografts or allografts
can be used.
Fig. 10
Fig. 11
Prior to cutting the graft, ensure that the thumb screw is
unscrewed. Position the humeral head in the bone graft
cutter. (Fig. 10)
The graft is cut by firmly tightening the handle.
In the case of exceptionally hard bone, a mallet can be used
to strike the clamp.
The dural part of the harvested graft is cut with a
gougeforceps before it is removed. (Fig. 11)
Tightenen the thumb screw to remove the graft.(Fig. 12)
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Fig. 12
surgical technique
Once cut, the graft is placed in the window of the final
prosthesis before it is placed in the humerus. (Fig. 13)
Fig. 13
6.5 Cementing the Implant
After placing the diaphyseal plug, the humeral canal is dried
and cement is injected using a large syringe.
A surgical drain can be temporarily placed in the medullary
cavity.
Fig. 14
Ensure that the sutures into the diaphysis are sliding
properly before complete drying of the ciment. (Fig. 14)
6.6 Placement of Final Humeral Implant
Insert the final prosthesis using the prosthesis holder.
Adjust the height to the same level as defined during the
trial process.
Adjust retroversion by aligning the lateral fin of the
prosthesis with the previously made mark. This is then
confirmed using the retroversion rod attached to the
prosthesis holder. (Fig. 15)
Excess cement is removed with a curette.
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Fig. 15
surgical technique
6.7 Impaction of Humeral Insert
After the cement is dry, the selected polyethylene insert is
positioned by aligning the insert‘s orientation notch with the
metaphyseal pin.
Reduction with different sizes of trial humeral inserts can be
done to find the best muscular stability.
Once the final thickness is selected, the metaphyseal
component is thoroughly cleaned and dried.
Insert a metaphyseal plug and screw it into the base of the
metaphysis.
The final insert is impacted into the metaphysis or on the
lateralized spacer with the humeral insert impactor.
(Fig. 16a-b-c)
Fig. 16a
The prosthesis is then reduced.
If reduction is difficult, a prosthesis reducer can be used.
NOTE :
If a lateralized spacer is used, the spacer is impacted
into the metaphyseal cup with the humeral cap adaptor
impactor.
After impaction, the central securing screw is inserted and
fully tightened with the 3.5 mm screwdriver, thus securing
the spacer onto the metaphysis.
6.8 Reduction
Before joint reduction, the “Lasso Maneuver” is performed
by placing the sutures around the prosthesis neck at the level
of the polished area (Fig. 17). Once the sutures are in place
around the stem, the joint can be reduced properly.
Fig. 17
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Fig. 16b
Fig. 16c
surgical technique
6.9 Tuberosities fixation
6.9.1 Place Horizontal Cerclage Sutures around the Greater Tuberosity
Fixation of the tuberosities begins with fixation of the greater tuberosity.
The arm is placed in neutral position. A clamp is used to pull the greater tuberosity anteriorly, reducing the greater
tuberosity to the prosthesis. (Fig. 18)
Using the Nice Knot technique (REF p5), tie the two Niceloop without needle around the greater tuberosity
(one superior green, one inferior white), to secure the greater tuberosity to the prosthesis. (Fig. 18)
NOTE :
Tie the knot outside and
strengthen it before leading the
knot to the point of fixation you
want. The Nice Knot will be
finally secured by performing
3 alternating half-hitches or
surgeon knots.
Fig. 18
6.9.2 Place Horizontal Cerclage around the Lesser Tuberosity
The next step is to reduce the lesser tuberosity.
The two remaining horizontal Nice Loops with needles (one green, one white) which
had initially been passed through the posterior rotator cuff tendon and around
the prosthetic neck, are then passed through the subscapularis tendon
from inside.
The green Nice loop is passed through the superior
portion of the subscapularis tendon while the white
one is placed on the inferior part.
Both sutures are passed from inside to outside and are then
tied using the Nice Knot technique. (REF p5)
The sutures thereby give lateral stability to the tuberosities. (Fig. 19)
Fig. 19
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surgical technique
6.9.3 Secure the Greater and Lesser Tuberosities
Final tightening creates a vertical support from the diaphysis. The anterior suture is passed though the subscapularis
and tied using Nice Knot technique.
The second posterior suture is placed into to the infraspinatus insertion and tied using the Nice knot technique.
NOTE : Make sure that both sutures are sliding properly before performing the Nice Knot.
This technique provides solid and reproducible fixation of the tuberosities on the diaphysis. (Fig. 20)
Fig. 20
6.9.4 Tenodesis of the Long Head of the Biceps
After resecting the intra-articular portion of the long head of the biceps, a nonabsorbable suture is passed through
the tendon of the long head of the biceps. It is then reinserted in the bicipital groove.
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surgical technique
6.10 Trial and Closure
Peri-operative Trial
Pull the arm away from the body after reduction and fixation of tuberosities to ensure that there is no
"pistoning" effect. Complete separation of the prosthesis while pulling indicates inadequate tensioning of the
deltoid.
Abduction of the arm is performed to check that there is no impingement and that anterior elevation and
abduction have been restored.
External rotation with the elbow at the side (ER-1) assesses passive external rotation.
External rotation with the elbow abducted (ER-2) assesses the risk of possible future subluxation.
Internal rotation with the elbow at the side (IR-1) and in abduction (IR-2). Forearm must be parallel to the
thorax for IR-2 trial. This reflects the patient‘s future ability to move the hand to the back.
Adduct the arm to check that there is no impingement between the pillar of the scapula and the humeral
implant.
After reduction of the prosthesis, the coraco-biceps tendon should usually have sufficient muscular tension.
Closure
In the superolateral approach, the anterior deltoid is reattached to the acromion with a trans-osseous
nonabsorbable suture.
In the deltopectoral approach, full or partial reinsertion of the subscapularis is performed if possible.
Be prepared to place a surgical drain in the sub-acromial space to reduce the risk of hematoma, as it is common
in fracture cases.
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surgical technique
7. REHABILITATION
The arm is placed in a brace with the elbow close to the body in neutral or internal rotation.
An abduction splint can be used, especially in cases of anterior deltoid detachment when the superolateral
surgical approach was used.
Plan early rehabilitation adapted to the status of the patient‘s bony structures and soft tissues.
• Strengthen the Deltoid:
Starting from the sixth week with active exercises against resistance.
Strengthen external rotators with elbow close to body by means of isometric exercises against resistance.
If the deltoid attachment has not been disrupted, mobility is usually rapidly recovered.
• Reduce the Risk of Subluxation:
Retropulsion and external rotation must absolutely be avoided postoperatively, especially when the patient is in
decubitus position.
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surgical technique
8. COMPLICATIONS
Postoperative Stiffness
In case of significant preoperative stiffness, it may be difficult to regain mobility postoperatively.
Surgical arthrolysis in conjunction with capsulotomy may be required with the removal of soft tissue adhesions
and possibly removal of the tuberosities.
Postoperatively, the arm is usually immobilized in a shoulder abduction splint in 60 degrees abduction. Passive
elevation above the splint in the scapular plane is started immediately.
Prosthesis Instability
This is the consequence of insufficient deltoid tension. Possible causes:
• Stem positioned too low
• Sphere positioned too high
Good synthesis of the tuberosities increases the joint stability.
In case of early postoperative dislocation, closed reduction under general anesthesia is performed. If the
prosthesis is in good position with retroversion and good overall fracture alignment, then immobilization for 6
weeks normally restores stability of the prosthesis.
With early recurrence of instability, surgical revision is needed to check the position of the prosthesis.
Increase the humeral lateralization as necessary by adding a lateralized spacer at the level of the humeral
implant.
Scapula Notch
Impingement between the pillar of the scapula and the humeral implant can lead to scapular bone erosion
resulting in a scapular notch. This notch usually does not affect function or mobility. X-ray follow-ups are
recommended.
Absence of Active External Rotation
The absence of the teres minor and infraspinatus due to tendon cuff tear or fatty infiltration may be the cause of
loss of active external rotation.
In this case one may consider a latissimus dorsi transfer to the greater tuberosity of the humerus performed at the
same time as the Aequalis™ Reversed Fracture prosthesis procedure.
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surgical technique
9. AEQUALIS™ REVERSED NON REVERSED HEMI-PROSTHESIS ADAPTOR
TECHNIQUE
Indications
When during the primary surgery the glenoid bone stock appears to be insufficient to bear the reversed glenoid
components, or when glenoid bone fracture occurs during the surgical procedures, the non reversed
hemi-prosthesis adaptor and the union screw can be adapted to the humeral components in order to transform
the Aequalis™ Reversed Fracture Shoulder Prosthesis into a non reversed hemi-prosthesis.
When, in case of revision of a Aequalis™ Reversed Fracture Shoulder Prosthesis, the glenoid bone stock appears
to be insufficient to implant a base plate and a sphere of Aequalis™ Reversed range again, the use of the
non reversed hemi-prosthesis adaptor and the union screw allows for the transformation of the Aequalis™Reversed Fracture Shoulder Prosthesis into a non reversed hemi-prosthesis in order to avoid the revision of the
humeral components..
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surgical technique
9.1 Preparation of Metaphyseal Implant
Remove the polyethylene implant with an osteotome.
(Fig. 21)
9.2 Affixing Union Screw
Fig. 21
Union screw is screwed into the metaphysis. Tighten the
screw with a 14 mm wrench (Fig. 22) or with the wrench for
metaphyseal plug associated with a 4.5 mm screwdriver.
9.3 Implantation of Adaptor
Fig. 22
Clean the inner part of the metaphysis carefully.
The non reversed hemi-prosthesis impactor is screwed into
the handle of the humeral insert impactor.
Be sure to position the adaptor notch in line with the
metaphyseal plug.
The adaptor is then impacted with the hemi-prosthesis
impactor. (Fig. 23)
Fig. 23
9.4 Impaction of Humeral Head
After the adaptor is in place, the exposed tapered cone is
carefully dried and cleaned.
The Aequalis™ adaptor cap of the selected diameter is
impacted on the tapered cone of the union screw using the
glenoid sphere impactor. (Fig. 24a-b)
Fig. 24a
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Fig. 24b
surgical technique
10. ASSEMBLY OF PROSTHESIS HOLDER
10.1 Prosthesis Holder Components
Height gauge
connector (2)
Height
gauge (1)
Ruler (3)
Prosthesis holder (7)
Forearm
guide (6)
Marker (4)
Locking
screw (8)
Retroversion rod (5b)
Retroversion rod (5a)
NOTE :
Height gauge and retroversion rod are assembled onto the stem holder depending on operative side and
chosen approach.
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surgical technique
(3)
10.2 Assembly of Height Gauge
Insert and push
Assemble the height gauge (1) with the height gauge
connector (2). (Fig. 25)
(1)
(2)
Push the release button on the tip of the height gauge
connector to insert the height gauge ruler (3).
Assemble the height gauge marker (4) onto the height
gauge ruler (3).
Fig. 25
(4)
(7)
10.3 Assembly of Prosthesis Holder
Connect the height gauge to prosthesis holder (7) and
secure the device with locking screw.
(8)
Two positions (fig 26a-b) are possible according to surgical
approach used.
Fig. 26a
Secure the assembly to the trial stem or final stem with the
locking screw (8).
10.4 Assembly of Retroversion Rod
Fig. 26b
(5)
(5‘)
Fig. 27
Connect retroversion rod (5‘) to retroversion rod (5) and
attach the forearm guide (6). (Fig. 27)
Identify the appropriate side (L for Left and R for right) and
attach the retroversion rod (5) to prosthesis holder(7).
(Fig. 28)
(6)
(5)
Fig. 28
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color coding
Humeral Side
Trial Insert
Ø 36 mm centered + 6 mm
Ø 36 mm centered + 9 mm
Ø 36 mm centered + 12 mm
Ø 36 mm retentive + 6 mm
Ø 36 mm retentive + 9 mm
Ø 36 mm retentive+ 12 mm
Ø 42 mm centered + 6 mm
Ø 42 mm centered + 9 mm
Ø 42 mm centered + 12 mm
Ø 42 mm retentive + 6 mm
Ø 42 mm retentive + 9 mm
Ø 42 mm retentive+ 12 mm
Color
Reference
MWD060
MWD061
MWD062
MWD970
MWD971
MWD972
MWD980
MWD981
MWD982
MWD983
MWD984
MWD985
Yellow
Black
Green
Black
Trial Inserts
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color coding
Diameter
Color
Ø 7 mm
Ø 9 mm
Ø 11 mm
Ø 13 mm
Ø 15 mm
Yellow
Green
Blue
Pink
Gray
Ref.
Reamers
MWD211
MWD212
MWD213
MWD214
MWD215
Ref. Final
Stems
DWD911
DWD912
DWD913
DWD914
DWD915
Ref. Trial
Stems
MWD911
MWD912
MWD913
MWD914
MWD915
Reamers
Trial Stems
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Ref. Long Stems
L 170 mm L 180 mm L 210 mm
DWD941
DWD942 DWD961
DWD943 DWD962
DWD944 DWD963
instrumentation
Instrumentation - Humeral YKAD95
9
10
7
5
11
8
3
12
6
4
13
2
1
Ref. YRAD951
Cases
Description
Box / base
Box / insert
Box lid
Instrumentation
N°
Description
1
Plug positioner
2
Humeral insert impaction handle
3
Tip for humeral insert impaction
4
Tip for impaction of non reversed hemi-prosthesis adaptor
5
Wrench for metaphyseal plug and union screw
6
Screwdriver 4.5 mm
7
Bone graft pliers
8
Ruler 200 mm
9
Humeral trial stem Ø 7 mm
10
Humeral trial stem Ø 9 mm
11
Humeral trial stem Ø 11 mm
12
Humeral trial stem Ø 13 mm
13
Humeral trial stem Ø 15 mm
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Reference
YRAD951
YRAD952
NCR009
Quantity
1
1
1
Reference
MBO101
MWD421
MWD423
MWD424
MWD131
MWB012
MWA301
MDU502
MWD911
MWD912
MWD913
MWD914
MWD915
Quantity
1
1
1
1
1
1
1
1
1
1
1
1
1
instrumentation
Instrumentation - Humeral YKAD95
3
4
7
2
8
9
20
10
21
5
11
22
23
13
14 15 16 17
18
24
1
4’
6
19
12
25
Ref. YRAD952
Instrumentation
N°
Description
1
Prosthesis holder (Including nut MWD210)
2
Height gauge (including humeral lug MWD220)
3
Marker
4
Long retroversion pin
4‘
Short retroversion pin
5
Stabilizer
6
Metaphyseal reamer handle SZH
7
Ø 7 mm Diaphysis reamer
8
Ø 9 mm Diaphysis reamer
9
Ø 11 mm Diaphysis reamer
10
Ø 13 mm Diaphysis reamer
11
Ø 15 mm Diaphysis reamer
12
Ø 3.5 mm angled hexagonal screwdriver
Reference
MWD216
MWD217
MWD220
MWD218
MWD221
MWD219
MWB497
MWD211
MWD212
MWD213
MWD214
MWD215
MDM412
Quantity
1
1
1
2 or 1*
0 or 1*
1
1
1
1
1
1
1
1
Instrumentation Ø 36 mm
N°
Description
13
Ø 36 mmTrial spacer +9mm
14
Humeral Trial Insert Ø36 + 6mm
15
Humeral Trial Insert Ø36 + 9mm
16
Humeral Trial Insert Ø36 + 12mm
17
Retentive trial insert Ø36 mm + 6mm
18
Retentive trial insert Ø36 mm + 9mm
19
Retentive trial insert Ø36 mm + 12mm
Reference
MWD920
MWD060
MWD061
MWD062
MWD970
MWD971
MWD972
Quantity
1
1
1
1
1
1
1
Instrumentation Ø 42 mm
N°
Description
20
Humeral Trial Insert Ø42 + 6mm
21
Humeral Trial Insert Ø42 + 9mm
22
Humeral Trial Insert Ø42 +12mm
23
Retentive Trial Insert Ø42 + 6mm
24
Retentive Trial Insert Ø42 + 9mm
25
Retentive Trial Insert Ø42 + 12mm
Reference
MWD980
MWD981
MWD982
MWD983
MWD984
MWD985
Quantity
1
1
1
1
1
1
* Each set is provided with either 1 long and 1 short retroversion rod or 2 long retroversion rods
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134
27
implants
Humeral Implants
Aequalis™-Reversed Fracture Stems
Diameter
7 mm
9 mm
11 mm
13 mm
15 mm
Length
130 mm
130 mm
130 mm
130 mm
130 mm
Aequalis™-Reversed Fracture Long Stems*
Reference
DWD911
DWD912
DWD913
DWD914
DWD915
170 mm
DWD941
180 mm
210 mm
DWD942
DWD943
DWD944
DWD961
DWD962
DWD963
DWB010
Metaphyseal Plug
Lateralized Humeral Inserts
Diameter
36 mm
36 mm
36 mm
42 mm
42 mm
42 mm
Diam.\ L
7 mm
9 mm
11 mm
13 mm
Thickness
+ 6 mm
+ 9 mm
+ 12 mm
+ 6 mm
+ 9 mm
+ 12 mm
Retentive Humeral Inserts
Reference
DWD860
DWD861
DWD862
DWD966
DWD967
DWD968
Diameter
36 mm
36 mm
36 mm
42 mm
42 mm
42 mm
Thickness
+ 6 mm
+ 9 mm
+ 12 mm
+ 6 mm
+ 9 mm
+ 12 mm
Reference
DWD970
DWD971
DWD972
DWD976
DWD977
DWD978
Humeral Spacer
Description
Humeral spacer + 9 mm
including tightening screw
Reference
DWD920
Non reversed Hemi-Prosthesis
Description
Non reversed hemi-prosthesis adaptor
Including union screw metaphysis / adaptor
Humeral Head CoCr
Humeral Head CoCr
Diameter
50 mm
52 mm
Height
19 mm
23 mm
Size
Size 5
Size 5
Size 5
Length
36”
36”
36”
Reference
DWD922
DWD923
DWB251
DWB253
*Special request only.
NiceLoop™
Ref single pack
SMSL50101
SMSL50201
SMSL50301
Ref 12 pack
SMSL50103
SMSL50203
SMSL50303
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134
28
Color
Green
White
White/Green
Needle
KAC-25
KAC-25
KAC-25
notes
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134
29
notes
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134
30
notes
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134
31
US HEADQUARTERS
MANUFACTURER
Tornier, Inc
10801 Nesbitt Ave South
Bloomington, MN 55437
USA
+1 952 426 7600
INTERNATIONAL HEADQUARTERS
TORNIER SAS
161 rue Lavoisier
38330 Montbonnot Saint Martin
FRANCE
+33 (0)76 61 35 00
www.tornier.com
©2015 Tornier, SAS. All rights reserved. Aequalis™, Aequalis™ Reversed Fracture,Niceloop™, Tornier™ and
countries.
are trademarks or registered trademarks of Tornier in the U.S. and other
Prior to using any Tornier device, please review the instructions for use and surgical technique for a complete listing of indications, contraindications, warnings, precautions,
potential adverse events, and directions for use.
Aequalis™ Reversed Fracture - Surgical Technique - UDKT134